摘要
目的研究急性心源性肺水肿(ACPE)机械通气治疗方法,比较持续气道正压成比例压力支持(CPAPPPS)、持续气道正压压力支持通气(CPAPPSV)两种模式对血流动力学的影响。方法77例ACPE患者进行无创、有创机械通气治疗,对其中机械通气时间超过24h的61例患者在有创机械通气开始与低辅助通气时用部分CO2重复呼吸法(无创心排血量,NICO)监测血流动力学变化,在药物干预下,对照研究两种模式下血流动力学变化。结果61例ACPE患者中33例行无创机械通气,成功24例(72.7%),33例有创机械通气(5例为无创转为有创机械通气),11例失败。控制通气应用双水平气道正压/压力支持通气(BIPAP/PSV),高水平压力(Phigh)16～24cmH2O(1cmH2O=0.098kPa),高水平压力时间(Thigh)1.5s,呼气末正压(PEEP)6～15cmH2O,吸入氧浓度(FiO2)0.5;有创机械通气撤机成功患者心排血量(CO)和心排血指数(CI)较有创机械通气撤机失败患者明显改善,低辅助通气采用PPS模式患者的CO和CI较采用PSV模式患者改善更明显(P均<0.001),有创机械通气撤机失败患者在药物干预下仍CI<1.5L·min-1·m-2。结论对ACPE患者应在血流动力学监测下进行药物干预及无创/有创机械通气治疗,宜采用压力控制模式,个体化调节PEEP,一般6～15cmH2O,依据临床情况尽快过渡到自主通气模式,对撤机困难者可应用CPAPPPS模式。
Objective To study the application of mechanical ventilation in acute cardiogenic pulmonary edema （ACPE）, and compare the changes in hemodynamics between continuous positive airway pressure-proportional pressure support （CPAP -PPS） with continuous positive airway pressure -pressure support ventilation （CPAP - PSV）. Methods Non-invasive and invasive ventilation were performed in 77 ACPE patients. At the initiation of invasive ventilation and the phase of low assist ventilation in 61 patients who were treated with mechanical ventilation longer than 24 hours, hemodynamics was monitored by partial CO2 rebreathing method （non-invasive cardiac output, NICO） cardiopulmonary management system, and then compare the changes in the two kinds of ventilation under medicinal intervention. Results Among 33 of 61 ACPE patients underwent non-invasive ventilation, 24 were successful, and the ratio was 72.7%. Among 33 patients with invasive ventilation （including 5 in whom ventilation was switched to non-invasive mode）, 11 failed. Biphasic positive airway pressure/pressure support ventilation （BIPAP/PSV） was used in pressure controlled ventilation, with high pressure （Phigh） 16 -24 cm H2O （1cm H2O=0. 098 kPa）, time of high pressure （Thigh） 1.5 seconds, positive end-expiratory pressure （PEEP） 6 - 15 cm H2O, fractional concentration of inspired oxygen （FiO2） 0.5, cardiac output （CO）/cardiac index （CI） was significantly improved compared with those of initial ventilation in successful ones in invasive group, and the improvement was more significant in PPS compared with PSV in low assist ventilation （all P〈0. 001）. Those in whom invasive ventilation was failed had a low CI （〈 1.5 L·min^-1·m^-2） even under drug intervention. Conclusion Hemodynamic monitoring should be performed when medicinal intervention and non-invasive/invasive ventilation are given to ACPE patients. Pressure controlled ventilation is recommended, and PEEP should be individualized （normally 6-15 cm H2O）. Spontaneous ventilation should be restored as soon as possible, CPAP - PPS mode is practicable in patients in whom weaning of mechanical ventilation is difficult.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2006年第6期350-354,共5页
Chinese Critical Care Medicine
基金
天津市自然科学基金资助项目(023612211)
关键词
肺水肿
心源性
急性
血流动力学
机械通气
acute cardiogenic pulmonary edema
hemodynamies
meehaniealventilation
